IRS Form W9 - Fillable Government and Business Forms in ...



Form W-9

(Rev. November 2005)

Department of the Treasury

Internal Revenue Service |Request for Taxpayer

Identification Number and Certification |Give form to the

requester. Do not

send to the IRS. | |

|Print or |Name (as shown on your income tax return) |

|type |      |

|See | |

|Specific | |

|Instructi| |

|ons on | |

|page 2. | |

| |Business name, if different from above |

| |      |

| | Individual/ Corporation Partnership Other ►       | |Exempt from backup |

| |Check appropriate box: Sole proprietor | |withholding |

| |Address (number, street, and apt. or suite no.) |Requester’s name and address (optional) |

| |      |      |

| |City, state, and ZIP code | |

| |      | |

| |List account number(s) here (optional) |

| |      |

|Part I Taxpayer Identification Number (TIN) |

|Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup |Social security number |

|withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole | |

|proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your | |

|employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. | |

|Note: If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.| |

| |  |

| |Employer identification number |

| |

|Under penalties of perjury, I certify that: |

|1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and |

|2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal |

|Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has |

|notified me that I am no longer subject to backup withholding, and |

|3. I am a U.S. person (including a U.S. resident alien). |

|Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup |

|withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. |

|For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement |

|arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must |

|provide your correct TIN. (See the instructions on page 4.) |

|Sign |Signature of |Date (      |

|Here |U.S. person( | |

|Purpose of Form |● An individual who is a citizen or resident of the United |

|A person who is required to file an information return with the |States, |

|IRS, must obtain your correct taxpayer identification number |● A partnership, corporation, company, or association |

|(TIN) to report, for example, income paid to you, real estate |created or organized in the United States or under the laws |

|transactions, mortgage interest you paid, acquisition or |of the United States, or |

|abandonment of secured property, cancellation of debt, or |● Any estate (other than a foreign estate) or trust. See |

|contributions you made to an IRA. |Regulations sections 301.7701-6(a) and 7(a) for additional |

|U.S. person. Use Form W-9 only if you are a U.S. person |information. |

|(including a resident alien), to provide your correct TIN to the |Special rules for partnerships. Partnerships that conduct a |

|person requesting it (the requester) and, when applicable, to: |trade or business in the United States are generally required |

|1. Certify that the TIN you are giving is correct (or you are |to pay a withholding tax on any foreign partners’ share of |

|waiting for a number to be issued), |income from such business. Further, in certain cases where a |

|2. Certify that you are not subject to backup withholding, or |Form W-9 has not been received, a partnership is required to |

|3. Claim exemption from backup withholding if you are a |presume that a partner is a foreign person, and pay the |

|U.S. exempt payee. |withholding tax. Therefore, if you are a U.S. person that is a |

|In 3 above, if applicable, you are also certifying that as a |partner in a partnership conducting a trade or business in the |

|U.S. person, your allocable share of any partnership income |United States, provide Form W-9 to the partnership to |

|from a U.S. trade or business is not subject to the |establish your U.S. status and avoid withholding on your |

|withholding tax on foreign partners’ share of effectively |share of partnership income. |

|connected income. |The person who gives Form W-9 to the partnership for |

|Note. If a requester gives you a form other than Form W-9 to |purposes of establishing its U.S. status and avoiding |

|request your TIN, you must use the requester’s form if it is substantially |withholding on its allocable share of net income from the |

|similar to this Form W-9. |partnership conducting a trade or business in the United |

|For federal tax purposes, you are considered a person if you |States is in the following cases: |

|are: |● The U.S. owner of a disregarded entity and not the entity, |

| |Cat. No. 10231X |Form W-9 (Rev. 11-2005) |

|Form W-9 (Rev. 11-2005) |Page 2 |

|● The U.S. grantor or other owner of a grantor trust and not | 3. The IRS tells the requester that you furnished an |

|the trust, and |incorrect TIN, |

|● The U.S. trust (other than a grantor trust) and not the |4. The IRS tells you that you are subject to backup |

|beneficiaries of the trust. |withholding because you did not report all your interest and |

|Foreign person. If you are a foreign person, do not use |dividends on your tax return (for reportable interest and |

|Form W-9. Instead, use the appropriate Form W-8 (see |dividends only), or |

|Publication 515, Withholding of Tax on Nonresident Aliens |5. You do not certify to the requester that you are not |

|and Foreign Entities). |subject to backup withholding under 4 above (for reportable |

|Nonresident alien who becomes a resident alien. |interest and dividend accounts opened after 1983 only). |

|Generally, only a nonresident alien individual may use the |Certain payees and payments are exempt from backup |

|terms of a tax treaty to reduce or eliminate U.S. tax on |withholding. See the instructions below and the separate |

|certain types of income. However, most tax treaties contain a |Instructions for the Requester of Form W-9. |

|provision known as a “saving clause.” Exceptions specified |Also see Special rules regarding partnerships on page 1. |

|in the saving clause may permit an exemption from tax to |Penalties |

|continue for certain types of income even after the recipient |Failure to furnish TIN. If you fail to furnish your correct TIN |

|has otherwise become a U.S. resident alien for tax purposes. |to a requester, you are subject to a penalty of $50 for each |

|If you are a U.S. resident alien who is relying on an |such failure unless your failure is due to reasonable cause |

|exception contained in the saving clause of a tax treaty to |and not to willful neglect. |

|claim an exemption from U.S. tax on certain types of income, |Civil penalty for false information with respect to |

|you must attach a statement to Form W-9 that specifies the |withholding. If you make a false statement with no |

|following five items: |reasonable basis that results in no backup withholding, you |

|1. The treaty country. Generally, this must be the same |are subject to a $500 penalty. |

|treaty under which you claimed exemption from tax as a |Criminal penalty for falsifying information. Willfully |

|nonresident alien. |falsifying certifications or affirmations may subject you to |

|2. The treaty article addressing the income. |criminal penalties including fines and/or imprisonment. |

|3. The article number (or location) in the tax treaty that |Misuse of TINs. If the requester discloses or uses TINs in |

|contains the saving clause and its exceptions. |violation of federal law, the requester may be subject to civil |

|4. The type and amount of income that qualifies for the |and criminal penalties. |

|exemption from tax. |Specific Instructions |

|5. Sufficient facts to justify the exemption from tax under |Name |

|the terms of the treaty article. |If you are an individual, you must generally enter the name |

|Example. Article 20 of the U.S.-China income tax treaty |shown on your income tax return. However, if you have |

|allows an exemption from tax for scholarship income |changed your last name, for instance, due to marriage |

|received by a Chinese student temporarily present in the |without informing the Social Security Administration of the |

|United States. Under U.S. law, this student will become a |name change, enter your first name, the last name shown on |

|resident alien for tax purposes if his or her stay in the United |your social security card, and your new last name. |

|States exceeds 5 calendar years. However, paragraph 2 of |If the account is in joint names, list first, and then circle, |

|the first Protocol to the U.S.-China treaty (dated April 30, |the name of the person or entity whose number you entered |

|1984) allows the provisions of Article 20 to continue to apply |in Part I of the form. |

|even after the Chinese student becomes a resident alien of |Sole proprietor. Enter your individual name as shown on |

|the United States. A Chinese student who qualifies for this |your income tax return on the “Name” line. You may enter |

|exception (under paragraph 2 of the first protocol) and is |your business, trade, or “doing business as (DBA)” name on |

|relying on this exception to claim an exemption from tax on |the “Business name” line. |

|his or her scholarship or fellowship income would attach to |Limited liability company (LLC). If you are a single-member |

|Form W-9 a statement that includes the information |LLC (including a foreign LLC with a domestic owner) that is |

|described above to support that exemption. |disregarded as an entity separate from its owner under |

|If you are a nonresident alien or a foreign entity not subject |Treasury regulations section 301.7701-3, enter the owner’s |

|to backup withholding, give the requester the appropriate |name on the “Name” line. Enter the LLC’s name on the |

|completed Form W-8. |“Business name” line. Check the appropriate box for your |

|What is backup withholding? Persons making certain |filing status (sole proprietor, corporation, etc.), then check |

|payments to you must under certain conditions withhold and |the box for “Other” and enter “LLC” in the space provided. |

|pay to the IRS 28% of such payments (after December 31, |Other entities. Enter your business name as shown on |

|2002). This is called “backup withholding.” Payments that |required federal tax documents on the “Name” line. This |

|may be subject to backup withholding include interest, |name should match the name shown on the charter or other |

|dividends, broker and barter exchange transactions, rents, |legal document creating the entity. You may enter any |

|royalties, nonemployee pay, and certain payments from |business, trade, or DBA name on the “Business name” line. |

|fishing boat operators. Real estate transactions are not |Note. You are requested to check the appropriate box for |

|subject to backup withholding. |your status (individual/sole proprietor, corporation, etc.). |

|You will not be subject to backup withholding on payments |Exempt From Backup Withholding |

|you receive if you give the requester your correct TIN, make |If you are exempt, enter your name as described above and |

|the proper certifications, and report all your taxable interest |check the appropriate box for your status, then check the |

|and dividends on your tax return. |“Exempt from backup withholding” box in the line following |

|Payments you receive will be subject to backup |the business name, sign and date the form. |

|withholding if: | |

|1. You do not furnish your TIN to the requester, | |

|2. You do not certify your TIN when required (see the Part | |

|II instructions on page 4 for details), | |

|Form W-9 (Rev. 11-2005) |Page 3 |

| Generally, individuals (including sole proprietors) are not |Part I. Taxpayer Identification |

|exempt from backup withholding. Corporations are exempt |Number (TIN) |

|from backup withholding for certain payments, such as |Enter your TIN in the appropriate box. If you are a resident |

|interest and dividends. |alien and you do not have and are not eligible to get an SSN, |

|Note. If you are exempt from backup withholding, you |your TIN is your IRS individual taxpayer identification number |

|should still complete this form to avoid possible erroneous |(ITIN). Enter it in the social security number box. If you do |

|backup withholding. |not have an ITIN, see How to get a TIN below. |

|Exempt payees. Backup withholding is not required on any |If you are a sole proprietor and you have an EIN, you may |

|payments made to the following payees: |enter either your SSN or EIN. However, the IRS prefers that |

|1. An organization exempt from tax under section 501(a), |you use your SSN. |

|any IRA, or a custodial account under section 403(b)(7) if the |If you are a single-owner LLC that is disregarded as an |

|account satisfies the requirements of section 401(f)(2), |entity separate from its owner (see Limited liability company |

|2. The United States or any of its agencies or |(LLC) on page 2), enter your SSN (or EIN, if you have one). If |

|instrumentalities, |the LLC is a corporation, partnership, etc., enter the entity’s |

|3. A state, the District of Columbia, a possession of the |EIN. |

|United States, or any of their political subdivisions or |Note. See the chart on page 4 for further clarification of |

|instrumentalities, |name and TIN combinations. |

|4. A foreign government or any of its political subdivisions, |How to get a TIN. If you do not have a TIN, apply for one |

|agencies, or instrumentalities, or |immediately. To apply for an SSN, get Form SS-5, |

|5. An international organization or any of its agencies or |Application for a Social Security Card, from your local Social |

|instrumentalities. |Security Administration office or get this form online at |

|Other payees that may be exempt from backup |. You may also get this form by |

|withholding include: |calling 1-800-772-1213. Use Form W-7, Application for IRS |

|6. A corporation, |Individual Taxpayer Identification Number, to apply for an |

|7. A foreign central bank of issue, |ITIN, or Form SS-4, Application for Employer Identification |

|8. A dealer in securities or commodities required to register |Number, to apply for an EIN. You can apply for an EIN online |

|in the United States, the District of Columbia, or a |by accessing the IRS website at businesses and |

|possession of the United States, |clicking on Employer ID Numbers under Related Topics. You |

|9. A futures commission merchant registered with the |can get Forms W-7 and SS-4 from the IRS by visiting |

|Commodity Futures Trading Commission, | or by calling 1-800-TAX-FORM |

|10. A real estate investment trust, |(1-800-829-3676). |

|11. An entity registered at all times during the tax year |If you are asked to complete Form W-9 but do not have a |

|under the Investment Company Act of 1940, |TIN, write “Applied For” in the space for the TIN, sign and |

|12. A common trust fund operated by a bank under |date the form, and give it to the requester. For interest and |

|section 584(a), |dividend payments, and certain payments made with respect |

|13. A financial institution, |to readily tradable instruments, generally you will have 60 |

|14. A middleman known in the investment community as a |days to get a TIN and give it to the requester before you are |

|nominee or custodian, or |subject to backup withholding on payments. The 60-day rule |

|15. A trust exempt from tax under section 664 or |does not apply to other types of payments. You will be |

|described in section 4947. |subject to backup withholding on all such payments until you |

|The chart below shows types of payments that may be |provide your TIN to the requester. |

|exempt from backup withholding. The chart applies to the |Note. Writing “Applied For” means that you have already |

|exempt recipients listed above, 1 through 15. |applied for a TIN or that you intend to apply for one soon. |

| |Caution: A disregarded domestic entity that has a foreign |

| |owner must use the appropriate Form W-8. |

|IF the payment is for . . . |THEN the payment is exempt | |

| |for . . . | |

|Interest and dividend payments |All exempt recipients except | |

| |for 9 | |

|Broker transactions |Exempt recipients 1 through 13. | |

| |Also, a person registered under | |

| |the Investment Advisers Act of | |

| |1940 who regularly acts as a | |

| |broker | |

|Barter exchange transactions |Exempt recipients 1 through 5 | |

|and patronage dividends | | |

|Payments over $600 required |Generally, exempt recipients | |

|to be reported and direct |1 through 7 | |

|sales over $5,000 1 | | |

|1See Form 1099-MISC, Miscellaneous Income, and its instructions. | |

|2However, the following payments made to a corporation (including gross | |

|proceeds paid to an attorney under section 6045(f), even if the attorney is a| |

|corporation) and reportable on Form 1099-MISC are not exempt from | |

|backup withholding: medical and health care payments, attorneys’ fees; and | |

|payments for services paid by a federal executive agency. | |

|Form W-9 (Rev. 11-2005) |Page 4 |

|Part II. Certification |What Name and Number To Give the |

|To establish to the withholding agent that you are a U.S. |Requester |

|person, or resident alien, sign Form W-9. You may be | |

|requested to sign by the withholding agent even if items 1, 4, | |

|and 5 below indicate otherwise. | |

|For a joint account, only the person whose TIN is shown in | |

|Part I should sign (when required). Exempt recipients, see | |

|Exempt From Backup Withholding on page 2. | |

|Signature requirements. Complete the certification as | |

|indicated in 1 through 5 below. | |

|1. Interest, dividend, and barter exchange accounts | |

|opened before 1984 and broker accounts considered | |

|active during 1983. You must give your correct TIN, but you | |

|do not have to sign the certification. | |

|2. Interest, dividend, broker, and barter exchange | |

|accounts opened after 1983 and broker accounts | |

|considered inactive during 1983. You must sign the | |

|certification or backup withholding will apply. If you are | |

|subject to backup withholding and you are merely providing | |

|your correct TIN to the requester, you must cross out item 2 | |

|in the certification before signing the form. | |

|3. Real estate transactions. You must sign the | |

|certification. You may cross out item 2 of the certification. | |

|4. Other payments. You must give your correct TIN, but | |

|you do not have to sign the certification unless you have | |

|been notified that you have previously given an incorrect TIN. | |

|“Other payments” include payments made in the course of | |

|the requester’s trade or business for rents, royalties, goods | |

|(other than bills for merchandise), medical and health care | |

|services (including payments to corporations), payments to a | |

|nonemployee for services, payments to certain fishing boat | |

|crew members and fishermen, and gross proceeds paid to | |

|attorneys (including payments to corporations). | |

|5. Mortgage interest paid by you, acquisition or | |

|abandonment of secured property, cancellation of debt, | |

|qualified tuition program payments (under section 529), | |

|IRA, Coverdell ESA, Archer MSA or HSA contributions or | |

|distributions, and pension distributions. You must give | |

|your correct TIN, but you do not have to sign the | |

|certification. | |

| |For this type of account: |Give name and SSN of: |

| |1. Individual |The individual |

| |2. Two or more individuals (joint |The actual owner of the account |

| |account) |or, if combined funds, the first |

| |3. Custodian account of a minor |individual on the account 1 |

| |(Uniform Gift to Minors Act) |The minor 2 |

| |4. a. The usual revocable |The grantor-trustee 1 |

| |savings trust (grantor is |The actual owner 1 |

| |also trustee) |The owner 3 |

| |b. So-called trust account | |

| |that is not a legal or valid | |

| |trust under state law | |

| |5. Sole proprietorship or | |

| |single-owner LLC | |

| |For this type of account: |Give name and EIN of: |

| |6. Sole proprietorship or |The owner 3 |

| |single-owner LLC | |

| |7. A valid trust, estate, or |Legal entity 4 |

| |pension trust | |

| |8. Corporate or LLC electing |The corporation |

| |corporate status on Form | |

| |8832 |The organization |

| |9. Association, club, religious, | |

| |charitable, educational, or |The partnership |

| |other tax-exempt organization | |

| |10.Partnership or multi-member |The broker or nominee |

| |LLC | |

| |11.A broker or registered |The public entity |

| |nominee | |

| |12.Account with the Department | |

| |of Agriculture in the name of | |

| |a public entity (such as a | |

| |state or local government, | |

| |school district, or prison) that | |

| |receives agricultural program | |

| |payments | |

| |1List first and circle the name of the person whose number you furnish. If |

| |only one person on a joint account has an SSN, that person’s number must |

| |be furnished. |

| |2Circle the minor’s name and furnish the minor’s SSN. |

| |3You must show your individual name and you may also enter your business |

| |or “DBA” name on the second name line. You may use either your SSN or |

| |EIN (if you have one). If you are a sole proprietor, IRS encourages you to |

| |use your SSN. |

| |4List first and circle the name of the legal trust, estate, or pension trust.|

| |(Do |

| |not furnish the TIN of the personal representative or trustee unless the |

| |legal |

| |entity itself is not designated in the account title.) Also see Special rules|

| |regarding partnerships on page 1. |

| |Note. If no name is circled when more than one name is |

| |listed, the number will be considered to be that of the first |

| |name listed. |

|Privacy Act Notice |

|Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns |

|with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or |

|abandonment of secured property, cancellation of debt, or contributions you made to an IRA, or Archer MSA or HSA. The IRS |

|uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this |

|information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. |

|possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal |

|and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat |

|terrorism. |

|You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable |

|interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply. |

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